IVH

IVH, or intraventricular hemorrhage, is bleeding into the ventricular system of the brain. It most commonly affects preterm infants and is a major complication of prematurity; fragile germinal matrix vessels and fluctuations in cerebral blood flow predispose to rupture. In some cases, IVH is associated with parenchymal injury or periventricular leukomalacia. The acronym is most often used in neonatology, though intraventricular hemorrhage can occur at other ages depending on context.

Classification and pathophysiology: The Papile system is widely used: Grade I is hemorrhage confined to the germinal matrix, Grade II is intraventricular blood without ventricular dilation, Grade III is intraventricular hemorrhage with hydrocephalus, and Grade IV involves parenchymal extension. Severity and coexisting brain injury influence outcomes.

Clinical features and diagnosis: In preterm infants IVH can be clinically subtle or present with apnea, lethargy, hypotonia, seizures, or a bulging fontanelle. Cranial ultrasound is the screening tool of choice in the NICU, performed serially in the first weeks of life. CT or MRI may be used for further assessment or in term infants.

Management and prognosis: Management is supportive, focusing on respiratory and hemodynamic stability, correction of coagulopathy if present, and treatment of hydrocephalus with drainage or shunting when needed. Seizures are treated with anticonvulsants. Prognosis depends on grade and associated brain injury; higher grades carry higher risk for hydrocephalus and neurodevelopmental impairment.

Prevention: Strategies include reducing prematurity, perinatal optimization, infection control, and careful neurological monitoring in at-risk infants.